Sensory Integration Disorder (long)

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Moonglow has been exploring Sensory Integration Disorder. I wrote this up for her and thought there might be general interest. I am biologist, not an Occupational Therapist (OT), but I have had to learn a whole lot about sensory integration to help my difficult child. This is the nickel tour, but I really encourage anyone interested to read Jean Ayers' book, "Sensory Integration and the Child" and/or "The Out-of-Sync Child" by Carol Stock Kranowitz. Ayers' book has a better description of the disorder, but the Kranowitz book is more readable.

Sensory Integration (SI) is how your brain handles the input that come from your senses - there's the regular 5 (smell, sound, touch, taste & sight) plus 3 others - tactile, proprioceptive, and praxis. Everyone integrates their senses to some degree. It's not that either you have it or you don't, but rather it's a continuum with some people having really good SI to someone who has terrible SI. Michael Jordan has really good Sensory Integration. My son has lousy SI. And, most people fall somewhere inbetween Michael and my difficult child. Also, a person can either over-react (hypersensitive) or under-react (hyposensitive) to a sensation. This is key as some kids with SI problems are, for example, terrified of swings (hypersensitive) and some want to swing all day long (hyposensitive). Both kids have SI problems.

Tactile is not the same as touch, but rather how things feel or appear to the person. Alot of kids with SI problems have Tactile Defensiveness. Examples are being irritated by tags or seams in their clothes, or types of fabric, or particular foods - could be texture, temperature, etc. An unwillingness to get messy - finger paint, mud, anything that would stick to hands. An extreme reaction to things that look gross to the child - rotting leaves in the gutter, messy dishwater in the sink. My son reacts to these visual images as strongly as most people react to a terrible smell. That is, he reacts to the look of rotting leaves like you might react to the smell of rotten eggs. He, literally, cannot stand to be near it. Alot of kids strongly resist changing their clothes because they don't want to have to get used to the feel of a whole new set. I put clean clothes on my difficult child at night and he sleeps in them - no more struggle to get him out of pajamas in the morning.

Proprioception is the sense of where your body is in relation to the center of gravity. SI problems cause a person to have a poor understanding of where their body is in relation to the earth and to gravity. Kids who don't like being moved off their center of gravity have "Gravitational Insecurity". My kid had this in spades. From birth he hated swings and would scream like crazy if we put him in the baby swing. Hated the johnny jump-up thing in the doorway. One of his first sentences was "No way-over." Way-over was his phrase for the sensation you get when the car turns a corner and your body is moved off center a bit. Whenever the car turned a sharp corner he would say "No way-over!" Parking ramps were no fun! He hated playground equipment of all sorts. Gravitational Insecurity is particularly a problem for a kid in school. Anytime they're standing in line and somebody bumps into them, they feel like they're flinging off the face of the earth. Frequently they hit the kids next to them, usually without even realizing that they did it. In kindergarten my difficult child was repeatedly amazed to find the child next to him crying, himself sent to the end of the line (or time-out), and the teacher scolding him when he didn't even realize that he had hit the child who bumped into him. To compensate for this poor understanding of where they are in relation to the earth, the SI child will often purposely crash into things/people/the floor in order to get more proprioceptive information to their brain. My difficult child used to throw himself to the floor many times a day. Alot of kids will repeatedly crash into other people. Babies will bang their heads on the floor or walls. It's all an effort to figure out where their body is in space.

Praxis is also called motor planning. It's the process that your brain and body have to go through in order to accomplish a task. Imagine that you want to walk across the room and sit down in a chair. First your brain has to conceive of each of the steps involved - put the right foot out, transfer the weight, put the left foot out, transfer the weight, right foot, left foot... When you reach the chair you have to turn around, back your legs up to the chair, lower your torso, sit on your bum, stretch your legs out and then relax. Some people have a problem with the conception phase, and some with the execution phase. A conception phase problem is an inability to conceive of the necessary steps involved. One of those two books has an example of a woman who had learned how to lie down on her bed to go to sleep. But when she went to the doctor's office and was told to lie down on the table she didn't know how. She only knew how to lie down on a bed, not a table. So she might climb up on to the table and stand up, then kneel down, then lie on her stomach, then roll over onto her back. She couldn't conceptualize the appropriate steps.
An execution phase problem might be tripping on the way over to the chair, lining up so that your bum is only half on the chair, then falling out of the chair once you try to sit down. Adults with motor planning problems have a hard time getting the address to show up in the little window when paying their bills. Kids with motor planning problems fall down alot. They seem to be able to trip over thin air. In fact, they are.

(My personal experience leads me to believe that there is another sense, as yet undefined, that relates to hearing the way tactile relates to touch. My difficult child and husband both have extreme reactions to music, one very negative and the other very positive. I'm exploring a sound therapy called Tomatis, but I don't know enough about it yet to explain it accurately.)

My difficult child has been going to an Occupational Therapist (OT) for 15 months, 2x/week for the first 6 months and 1x/week since. It has made a huge difference for him. His gravitional insecurity is virtually gone. His tactile defensiveness and motor planning are significantly improved. Although the therapy can be helpful at any age, including adults, I've been told that it is most effective in kids younger than 7. When you read these descriptions, remember that a kid can be either hyper- or hypo-sensitive. And sometimes they swing from one extreme to the other, particularly once they start to improve their SI. Although my difficult child's SI is vastly improved since therapy, when he is agitated or upset, many of the symptoms come back.

Also, lots of kids with SI and/or behavior problems also have developmental vision problems, which need to be evaluated by a Behavioral Ophthamologist. Regular eye doctors aren't trained to diagnose developmental vision problems. There is Vision Therapy to correct the vision problems. If the problems are left uncorrected it will cause big problems in school. We had no clue that our difficult child had vision problems until the Behavioral Ophthamologist showed me during the evaluation and he had MAJOR problems. Before we started Vision Therapy he would only read 1 or 2 sentences out of a book and then say he hated reading, this book is boring, etc. After 6 months of vision therapy he is reading at the 4th grade level (he's in 1st grade) and loves it (although he hates the therapy!).

So that's the nickel tour. I strongly suggest that you read those books and educate yourself as much as you can because, outside of Occupational Therapists, you will be hard-pressed to find anybody who knows anything about SI, and you will have to be your child's advocate - especially once he's in school.